Am J Manag Care. 2021 Jan;27(1 Spec. No.):SP37-SP43. doi: 10.37765/ajmc.2021.88562. Epub 2020 Dec 23.
Intravenous (IV) taxanes for metastatic breast cancer (mBC) are associated with toxicities, such as chemotherapy-induced peripheral neuropathy (CIPN), which can detrimentally impact outcomes.
To assess the impact of CIPN on clinical and economic outcomes in women with mBC, initiating IV paclitaxel/ nab-paclitaxel.
Adult women in the MarketScan Commercial and Medicare Supplemental Database with a mBC diagnosis, initiating IV paclitaxel or IV nab-paclitaxel (index date = first administration) from November 1, 2013, to September 30, 2018, who had no prior neuropathy diagnoses, and continuous enrollment 12 months prior to and ≥ 3 months following index were selected. Propensity score-matched CIPN and non-CIPN cohorts were defined, based on postindex CIPN diagnosis. Clinical characteristics and all-cause and breast cancer (BC)-related health care utilization and costs per patient per month (PPPM) were compared between matched CIPN and non-CIPN cohorts during follow-up.
Among the 5870 women with mBC initiating IV paclitaxel/nab-paclitaxel, 42.7% developed CIPN. The matched cohorts each included 1950 women. Patients with CIPN were more likely to have a dose reduction (46.1% vs 38.2%, P < .001) or develop depression, diabetes, insomnia, liver dysfunction, or arthritis compared with the non-CIPN cohort, P < .05. Patients with CIPN were more likely to have an inpatient admission (39.2% vs 34.9%, P < .01) or emergency department visit (46.7% vs 35.6%, P < .001), as well as all-cause and BC-related costs that were $1102 and $725 PPPM higher, respectively, than women without CIPN (P < .01).
CIPN was common in women, following IV paclitaxel/nab-paclitaxel treatment and was associated with dose reductions, the development of comorbidities, and elevated health care costs. Therapies for mBC that offer increased tolerability are needed to help improve patient outcomes and control costs.
转移性乳腺癌（mBC）的静脉内（IV）紫杉烷类药物与化疗引起的周围神经病变（CIPN）等毒性相关，这可能对结局产生不利影响。
评估 CIPN 对开始 IV 紫杉醇/白蛋白结合型紫杉醇治疗的 mBC 女性的临床和经济结局的影响。
从 2013 年 11 月 1 日至 2018 年 9 月 30 日，在 MarketScan 商业和医疗保险补充数据库中选择患有 mBC 诊断、开始 IV 紫杉醇或 IV 白蛋白结合型紫杉醇（索引日期=首次给药）且无先前神经病变诊断且在索引前 12 个月内和索引后至少 3 个月内连续入组的成年女性。根据索引后 CIPN 诊断，定义了 CIPN 和非 CIPN 队列。比较了随访期间匹配的 CIPN 和非 CIPN 队列中每位患者每月的全因和乳腺癌（BC）相关医疗保健利用率和成本（每患者每月[PPPM]）。
在开始 IV 紫杉醇/白蛋白结合型紫杉醇的 5870 名 mBC 女性中，42.7%发生了 CIPN。匹配的队列各包括 1950 名女性。与非 CIPN 队列相比，CIPN 患者更有可能减少剂量（46.1%比 38.2%，P<0.001）或出现抑郁、糖尿病、失眠、肝功能异常或关节炎，P<0.05。CIPN 患者更有可能住院（39.2%比 34.9%，P<0.01）或急诊就诊（46.7%比 35.6%，P<0.001），全因和 BC 相关的费用分别高出 1102 美元和 725 美元/患者/月（P<0.01）。
在接受 IV 紫杉醇/白蛋白结合型紫杉醇治疗后，女性中 CIPN 很常见，与剂量减少、合并症的发生和医疗保健费用的增加有关。需要提供耐受性更高的 mBC 治疗方法，以帮助改善患者结局并控制成本。
